Helen Hutchinson

Background/Objectives: Malnutrition is common among women undergoing gynaecologic oncology (GO) surgery and is associated with increased morbidity, prolonged hospitalisation, and reduced survival. Nevertheless, the optimal nutritional screening tools remain uncertain. Methods: We conducted a narrative review of commonly used nutritional screening and assessment tools in surgical GO patients. To highlight practical challenges in accurately identifying at risk individuals, we incorporated findings from our clinical audit. Results: There was a considerable variation between tools. While many tools were associated with adverse outcomes, their clinical value in this population was unclear. The presence of ascites and rapid deterioration in oral intake may contribute to under-recognition of at-risk patients, as illustrated by our audit findings. Emerging strategies including determining body composition from routine pre-operative Computed Tomography (CT) scans, which have shown statistical associations with survival and toxicity in observational studies, but their clinical utility is not yet established. Conclusions: Although several screening tools were statistically associated with adverse outcomes, robust data on their clinical utility are lacking. Current tools may inadequately factor for the specific considerations when screening this group. Consequently, nutritionally vulnerable surgical GO patients requiring nutritional intervention may be missed. As no gold standard currently exists for this population, bespoke, objective approaches and prospective studies are urgently needed to address disease-specific nutritional considerations.

Background/Objectives: Nutritional risk screening is critical in the management of gynaecologic oncology (GO) surgical patients. Malnutrition is prevalent in this population and is associated with poorer surgical outcomes, including increased morbidity, prolonged hospital stays, and reduced survival rates. Nevertheless, the optimal nutritional screening tools for this patient group remain undefined. Methods: We conducted a narrative review to critically appraise commonly used nutritional screening and assessment tools in surgical GO patients. To highlight practical challenges in accurately identifying at-risk individuals, we incorporated findings from our recent clinical audit. Results: Several nutritional screening and assessment tools were identified. The results varied considerably between tools. The presence of ascites and rapid deterioration in oral intake were frequently overlooked, leading to under-recognition of malnutrition. These issues were corroborated by our audit findings. Emerging strategies including determining body composition from routine preoperative CT scans show promise. Conclusions: Accurate nutritional assessment is imperative to improve surgical outcomes in surgical GO patients. As currently no gold standard currently exists for this population, bespoke approaches to address disease-specific nutritional considerations are urgently needed to identify those at risk and allow for timely nutritional interventions. Integrating CT-based body composition analysis can provide an objective solution, thus requiring further investigation.